Respiratory Examination PDF

Physical Examination in Respiratory System 1  Anatomy The respiratory system compromises the upper airway: the nose, mouth, oropharynx and larynx and the lower airway: trachea and lungs. There are approximately 300 million alveoli in each lun...

Physical Examination in Respiratory System 1  Anatomy The respiratory system compromises the upper airway: the nose, mouth, oropharynx and larynx and the lower airway: trachea and lungs. There are approximately 300 million alveoli in each lung giving a total surface area 40-80m2 for air exchange. The left lung contains only 45% of the total surface area available for gas exchange because the heart lies principally within left side of the chest.  Anterior imaginary lines and landmarks Suprasternal norch Supraclavicular fossa Infraclavicular fossa Sternal line Sternal angle Parasternal line Anterior midline Midclavicular line epigastric angle 5 Lateral imaginary lines Posterior axillary line Anterior axillary line Midaxillary line 6  Posterior imaginary lines and landmarks Suprascapular region Scapular region Interscapular region Infrascapular region Scapular line Posterior midline 7 Anterior view of lobes 8 Posterior view of lobes 9 Right lateral view of lobes 10 Left lateral view of lobes 11 History of the present illness The six cardinal symptoms of chest diseases are: 1- Cough 2- Expectoration (sputum) 3- Hemoptysis 4- Chest pain 5- Dyspnea 6- Wheezes 12  Cough It is a very common symptom of both upper and lower respiratory tract diseases. It may be dry (pharyngitis) or productive (bronchietasis, chronic bronchitis, Resolving Pneumonia) Persistent (pharyngitis) or episodic (bronchial asthma). Acute cough is one lasting less than 3 wks and chronic cough lasts more  Hemoptysis2:  Differentiate between hemoptysis and hematemesis  Ask about :  Ask about the preceding events e.g. DVT or chest infection. Causes of Hemoptysis could be Tumour, infection, or vascular causes. 18  Hemoptysis1: The most important causes of hemoptysis are Mitral stenosis Pulm tuberculosis Pulm infarction Brochiectasis Bronchogenic carcinoma Bronchial adenoma Bleeding tendency 19  Chest pain It is common symptom. Site and character of pain is different with the diseases. Retrosternal pain - it may be due to acute tranchietis. Mediastinal - emphysema or mediasnitis Wheeze differentiate between wheeze and stridor. Wheeze occurs due to narrowing of small airways Stridor occurs due to obstruction of major airways and it is audible only during inspiration. Wheezing may be intermittent as in asthma or persistent as in chronic bronchitis. Wheezing may be diffuse as in asthma and chronic bronchitis or localized as in bronchogenic carcinoma. 23  “Examine this patient’s chest” Introduce yourself Ask permission to examine Position the patient- the patient should lie supine with arms abducted to examine front and sides. For examination of the back the patient should sit up with arms crossing front of the chest. Expose the chest up to the umbilicus (female patient should not exposed except when it is necessary. 24  Be systematic Observe from end of the bed Examine –Hands –Face –Neck –Chest –Ankles 25  From the end of the bed Around the The patient patient Respiratory rate Oxygen Chest shape/ Inhalers/ movement nebulisers Stridor Cachexia Sputum pot Accessory muscle Cigarettes use Pursed lip breathing 26  Hands Clubbing Tar staining Tremor Asterixis Steroidal skin Wasting of small muscles Pulse Hypertrophic pulmonary osteoarthropathy (HPOA) 27  Face Pallor Dilated pupils Central cyanosis Horner’s syndrome -- Ca. bronchus Cushingoid appearance Hoarse voice 29 30 31  Neck Trachea Crico-sternal distance JVP Lymphadenopathy 32  The Chest Inspection Palpation Percussion Auscultation 33  Inspection of anterior chest wall Ask the patient to lie supine. Ask the patient to lower his gown to waist level. Stand at the feet of patient. Inspect the shape of the chest (ratio of antero-posterior and transverse diameters). Inspect the symmetry of the patient’s chest on both sides with comparison. 34  Inspection of anterior chest  Inspect patient’s wall chest normal breathing movement.  Inspect patient’s chest for accessory muscle use.  Inspect patient’s chest for retraction of lower intercostal spaces.  Stand again to the right of patient and look tangentially for apical and epigastric pulsation.  Inspect the chest wall and skin for swelling, scars, skin eruption or engorged veins. 35  Inspection 1. Prominent veins, pulsations, scars. 2. Respiratory rate 3. Type of respiration 4. Shape of the chest 5. Any chest deformity 6. Symmetry/Asymmetry of chest movement 36  Inspection 2. Normal Respiratory rate for adults: 12-20 b/min – Tachypnea: >20 b/min – Bradypnea: 5cm. If it is 500ml: breathlessness. Chest pain – Disappeared with growing of pleural effusion – Reappeared with the fluid decreasing Affected side lying Dyspnea, orthopnea, palpitation The symptoms of underlying disease 99  Signs (Moderate to massive effusion) Tachypnea Limited movement of affected side Costal interspaces of affected side are wider Trachea shifts to opposite side Decreased vocal fremitus Dullness or flatness Decreased or disappeared vesicular breath sound Decreased or disappeared vocal resonance Pleural friction rub Abnormal bronchial breath sound in upper area of the fluid 100 Pneumothorax 101  Symptoms Sudden chest pain Dyspnea Forced sitting position Unaffected side lying Dry cough  Tension pneumothorax – Progressive dyspnea – Severe sweat – Tachycardia – Tension, agitated – Cyanosis – Respiratory failure 102  Signs Costal interspaces in affected side are wider Limited movement of affected side Decreased or disappeared vocal fremitus Trachea and heart shift to opposite side Tympany Vesicular breath sound 103  Thanks for your attention